肝臟疾病本科

1、會計學1肝臟疾病本科肝臟疾病本科第1頁/共108頁第2頁/共108頁31: liver; 2: rib cage; 3: spine; 4: pelvis 第3頁/共108頁4第4頁/共108頁5第5頁/共108頁64-Cauinaud segmentation第6頁/共108頁75-left hepatic vein第7頁/共108頁86-middle hepatic vein第8頁/共108頁97- hepatic vein & portal vein第9頁/共108頁108- portal vein plane第10頁/共108頁11第11頁/共108頁12第12頁/共108頁1

2、39- circulation第13頁/共108頁14第14頁/共108頁第15頁/共108頁16第16頁/共108頁17第17頁/共108頁18第18頁/共108頁19Hepatic trauma -imaging findingsHydrops at the adrenal glandHepatic trauma with fracture of left rib第19頁/共108頁20J. David Richardson, et al. ANNALS OF SURGERY, 232( 3): 324330.第20頁/共108頁21第21頁/共108頁22第22頁/共108頁23第23頁

3、/共108頁24第24頁/共108頁第25頁/共108頁26第26頁/共108頁27第27頁/共108頁28第28頁/共108頁29第29頁/共108頁3020/100,00040/100,000NPCHCC第30頁/共108頁31中國是中國是HCCHCC高發(fā)地區(qū)高發(fā)地區(qū)Global Cancer Statistics, 2002. CA Cancer J Clin 2005;55;74-108n20022002年全球新發(fā)病例年全球新發(fā)病例 626,162626,162n中國病例占中國病例占5555，約，約344,000344,000n男性高發(fā)于女性男性高發(fā)于女性 (2.67 : (2.67

4、: 1)1)第31頁/共108頁32第32頁/共108頁33第33頁/共108頁34第34頁/共108頁35第35頁/共108頁36第36頁/共108頁37The satellite nodules of this hepatocellular carcinoma represent either intrahepatic spread of the tumor or multicentric origin of the tumor. 第37頁/共108頁38第38頁/共108頁39Coarse lamellar fibrosis is characteristic histologicall

5、y; note the pale body in the large eosinophilic malignant hepatocyte (X40). 第39頁/共108頁40This HCC is composed of liver cords that are much wider than the normal liver plate that is two cells thick. There is no discernable normal lobular architecture, though vascular structures are present. 第40頁/共108頁

6、41n早期無明顯癥狀：早期無明顯癥狀：即亞臨床肝癌（無癥狀和體征）n肝區(qū)疼痛肝區(qū)疼痛：常見的首發(fā)癥狀，持續(xù)性鈍痛、刺痛、脹痛；可伴牽涉痛n肝腫大肝腫大：中、晚期肝癌常見n消化道癥狀：消化道癥狀：腹脹、食欲減退、惡心嘔吐、腹瀉、出血n全身癥狀：全身癥狀：乏力、消瘦、低熱n晚期肝癌癥狀：晚期肝癌癥狀：貧血、黃疸、腹水、浮腫、惡液質n癌腫轉移部位的相應癥狀：癌腫轉移部位的相應癥狀：肺、骨、腦n伴癌綜合癥伴癌綜合癥：低血糖癥、紅細胞增多癥、女性男性化 第41頁/共108頁42第42頁/共108頁43第43頁/共108頁44第44頁/共108頁45n介入后第45頁/共108頁46HCC-Imaging

7、findingsCT scan Arterial phase Portal vein phase第46頁/共108頁47第47頁/共108頁48第48頁/共108頁49The presence of macrotrabecular architecture in this fragmented area allowed for establishing the diagnosis of HCC (X40). 第49頁/共108頁50第50頁/共108頁51第51頁/共108頁52極早期極早期 (0)PS 0, CPA早期早期(A)PS 0, CPA-B中期中期(B)PS 0, CPA-B晚期晚

8、期(C)PS 1-2, CPA-B終末期終末期(D)PS 2, CPCHCC隨機對照試驗（隨機對照試驗（50%）中位生存時間中位生存時間11-20月月 對癥對癥(20%)生存期生存期3月月HCCHCC BCLC staging and treatmentBCLC staging and treatmentSem Liv Dis 1999 to J Hepatol 2008;48:S20-S37治愈性治療（治愈性治療（3030）5 5年生存率年生存率40%-70%40%-70%肝移植肝移植RF/PEI切除術切除術伴隨疾病伴隨疾病有有無無3 個結節(jié)個結節(jié), 3cm上升上升正常正常單發(fā)結節(jié)單發(fā)結節(jié),

9、2cm門脈壓力門脈壓力/膽紅素膽紅素單發(fā)結節(jié)單發(fā)結節(jié)多多結節(jié)結節(jié), 3cmTACE多個腫瘤多個腫瘤門脈轉移門脈轉移,N1,M1PS: performance status，ECOG體能狀態(tài)評分體能狀態(tài)評分 CP: Child-Pugh 評級評級新藥治療新藥治療索拉非尼索拉非尼第52頁/共108頁53第53頁/共108頁54第54頁/共108頁55第55頁/共108頁56* 中華醫(yī)學雜志中華醫(yī)學雜志, 2003 , 83 (12):1053-7.第56頁/共108頁57第57頁/共108頁58第58頁/共108頁59口服藥物：最新研究結果在重要醫(yī)學雜志先后發(fā)表口服藥物：最新研究結果在重要醫(yī)學雜志

10、先后發(fā)表SHARP研究研究New England Journal Medicine Llovet JM et al，2008;359:378-90.Oriental研究研究Lancet Oncology Cheng AL et al，2008年年12月在線發(fā)表月在線發(fā)表Llovet JM et al. N Engl J Med 2008;359:378-90.Cheng AL et al. Lacnet Oncoligy 2008 Dec 17 online publish .第59頁/共108頁第60頁/共108頁第61頁/共108頁62第62頁/共108頁63This large soli

11、tary metastatic nodule was from a colon primary; the glairy cut surface represents a high mucin content. 第63頁/共108頁64Multiple confluent nodules with central umbilication and peripheral hyperemia are classic for metastasis to liver; the primary here was a breast carcinoma. 第64頁/共108頁65第65頁/共108頁66第66

12、頁/共108頁67第67頁/共108頁68第68頁/共108頁69第69頁/共108頁70第70頁/共108頁71第71頁/共108頁第72頁/共108頁第73頁/共108頁74第74頁/共108頁75The honeycomb appearance and vascular nature of this giant cavernous hemangioma are readily apparent from the capsular surface. 第75頁/共108頁76HemangiomasSequential changes during angiograpgy: a vascula

13、r lesion with delayed clearing of the contrast medium. 第76頁/共108頁77The cut surface of this hemangioma varies from honeycomb to spongy to fibrotic (photograph courtesy of S. Goetz, M.D.). 第77頁/共108頁第78頁/共108頁79第79頁/共108頁80Polycystic liver and kidney disease at autopsy; the liver was completely normal

14、 functionally (photograph courtesy of Chris Reuter, M.D.). 第80頁/共108頁81Hepatic cysts-imaging findingsHepatic cysts with intra-abdominal hydrops第81頁/共108頁82第82頁/共108頁第83頁/共108頁84第84頁/共108頁85Liver adenoma第85頁/共108頁86The cut surface of the liver reveals the hepatic adenoma. Note how well circumscribed

15、it is. The remaining liver is a pale yellow brown because of fatty change from chronic alcoholism.第86頁/共108頁87Hepatic adenomas can become so large as to be life-threatening. This estrogen related adenoma, benign histologically, replaced much of the liver, leading to the patients demise. 第87頁/共108頁88

16、Hepatic adenomaNormal liver tissue with a portal tract is seen on the left. The hepatic adenoma is on the right and is composed of cells that closely resemble normal hepatocytes, but the neoplastic liver tissue is disorganized hepatocyte cords and does not contain a normal lobular architecture. The

17、hemorrhagic area represents the peliosis like change commonly seen in estrogen related adenomas (X3.3). 第88頁/共108頁第89頁/共108頁90第90頁/共108頁91Focal nodular hyperplasiaA classic focal nodular hyperplasia, paler than the surrounding liver, and with a distinct central stellate scar. The bands of fibrosis impart an appearance mimicking that of macronodular cirrhosis (Klatskin, X5). 第91頁/共108頁第92頁/共108頁93第93頁/共108頁94第94